两种不同麻醉方式应激反应的影响PPT课件.pptx

Effectof2differentanesthesiamethodsonstressresponseinneurosurgicalpatientswithhypertensionornormalAprospectiveclinicaltrial,Medicine.95(35):e4769,August2016YingChen,MDa,ShanJiang,MDb,YongWu,MDa,Speaker:liujie2016.10.31,.,Introduction,stressresponseNeurosurgerytrauma,anesthesia,hypoxia,andpaincanmakethebodyproducethestressresponsebodyproducesseveremetabolicandhomeostasisdisordersandimmunesuppressionleadingtomassivereleaseofhormonesandbloodsugarintothebloodcausingseriousphysiologicaldysfunction,inflammation,andproliferation（增生）high-sensitivityC-reactiveprotein(Hs-CRP)（超敏C反应蛋白）concentrationincreasingdramaticallymightbeasensitiveindicatorofinflammationandtissuedamage.,Introduction,hypertensionhypertensionisaspecialdisease,especiallylong-termhighbloodpressurebodyfunctionsaredegradedcorrespondingpathologicalchangeshypertensionpatientsaremorelikelytohavestrongstressresponsecausedbyinjuryofsurgeryoperationcomparedwithnon-hypertensionpatients,Introduction,anesthesiamethodsTheanesthesiamethodsmayhaveconsiderableinfluenceonthesurgicalstressresponseandthepostoperativeimmuneresponseSurgery-inducedinflammatoryresponseandalterationincell-mediatedimmunityseemtobemorepronouncedafterbalancedanesthesiabyenhancingstressresponse.Thebenefitoftotalintravenousanesthesiamightcontributetothepreventionofexcessivepostoperativeinflammation.,Introduction,therelationshipbetweenhypertensionandanesthesiamethodsisunclearonthestressresponseThepurposeofthisstudyistocomparetheeffectofdifferentanesthesiamethodsonhigh-sensitivityC-reactiveprotein(Hs-CRP),bloodglucose,andleucocytelevelsinneurosurgicalpatientswithhypertensionornormal.,Materialsandmethods,SubjectsEightyelectiveneurosurgicalpatientsaged40to65intracranialaneurysmsurgery（脑动脉瘤手术),sellar(蝶鞍区）surgery,meningioma（脑膜瘤）surgery,orcerebraldecompression（减压术）ThepatientswithhypertensionhadbeendiagnosedwithstageIhypertensionforatleast1yearandthebloodpressurewasundercontrolwithmedication.hadnottakenanyothermedicationthatinfluencedtheflowdynamicsrecentlybesidesthehypertensiondrugs.Thebloodpressureofhypertensionpatientsmustbecontrolledat140/90mmHgbeforethesurgeryand180/110mmHgduringthesurgery.Allpatientswithgeneralanesthesiaforendotrachealintubation,Materialsandmethods,Subjectsrandomlydividedintofourgroups:balancedanesthesiagroup(A),balancedanesthesiawithhypertensiongroup(B),totalintravenousanesthesiagroup(C)andtotalintravenousanesthesiawithhypertensiongroup(D),Materialsandmethods,SubjectsPatientswithendocrinesystemdisease,respiratorysystemdisease,seriouscardiovasculardisease,liverandkidneydysfunction,obesity,andcachexia（恶病质）wereexcludedPatientscouldnthavehistoryofdrugoralcoholaddictionandpsychiatricdisorders,Materialsandmethods,Anesthesiavenousinfusionpathwaywasestablished30minutesbeforeanesthesiaphenobarbitalsodiuminjection0.02mg/kg,atropine0.007to0.01mg/kginductionofgeneralanesthesia:midazolam0.05to0.1mg/kg,fentanyl,4ug/kg,and2to3mg/kgofpropofol,atracurium0.5to0.6mg/kgunderwentrapidinductionandtrachealintubationmechanicalventilation,Materialsandmethods,Anesthesiatotalintravenousanesthesia:fentanyl0.05to0.10ug/kg/min,3to4mg/kg/hpropofolinfusionmaintained;balancedanesthesia:isofluraneinhalation,andintermittentintravenousfentanyl1to2mg/kg.Eachgroupmaintainedmusclerelaxationwithatracurium0.2to0.3mg/kgcontinuousinfusion.,Materialsandmethods,AnesthesiaAllpatientswerecontinuouslymonitoredheartrate,bloodpressure,respirationrate,andbloodoxygensaturation.Thebloodpressurewasmaintainedatbetween140and120/90and70mmHgcontinuousintravenousnitroglycerinweregivenifthemalignantbloodpressureemerged,djustedbythebloodpressurechangestokeepbloodpressurestable.Otherspecialistcareandspecialtreatmentwereconductedasusual,Materialsandmethods,Detectionmethodandtheobservationindexextractedveinblood5mLat4times:beforesurgery(T0),duringsurgery(T1),2hoursaftersurgery(T2),and24hoursaftersurgerySerumlevelsofhighsensitiveC-reactiveproteinwasdetectedbyenzyme-linkingimmune-absorbentassay(酶联免疫吸附试验，ELISA）Thelevelsofbloodglucoseandleukocytecountweremeasuredrespectivelybybloodglucosemeterandautomaticbloodcellcountingequipment.,Materialsandmethods,StatisticalanalysisMeanandstanddeviationateachmeasuretimewithingroupwerereported.TwosidedpairedttestwasconductedtocomparethemeanbetweentimeT0withothertimeswithinthesamegroup.One-wayanalysisofvariance(ANOVA)wasusedtotestwhethertherewasanysignificantdifferencebetweenthehypertensionandnon-hypertensiongroupsbeforethesurgery.Two-wayANOVAwasperformedtoexaminetheinfluenceofanesthesiamethodandhypertensionhistoryontheinterestedoutcomes.SPSS13.0(SPSSInc.,Chicago,IL)wasusedtoperformthestatisticalanalyses,Results,Demographicdata:nodifference,Results,Hs-CRPexpressionHs-CRPexpressionintheA,B,C,andDgroupsdecreasedatT0,T1,T2timepoint,butincreasedatT3(?)attimeT0,PatientswithhypertensionhadhigherHs-CRPexpressionthanthoseofnormal(P0.01)patientswithhypertensioninDgrouphadlowerHs-CRPexpressionthanthoseinBgroupattimeT3(P0.01)Innormalpatients,Hs-CRPexpressioninCgroupwaslowerthanthoseinAgroupattimeT3(P0.01)BothhypertensionhistoryandanesthesiamethodhadsignificanteffectsontheHs-CRPexpression,Results,Hs-CRPexpression,High-sensitivityC-reactiveproteinexpressionchangesineachgroup(xS,n=20).,Results,Bloodglucose,leukocytecount,andneutrophilpercentageBloodglucose,leukocytecount,andneutrophilpercentageincreasedattimeT0,T1,T2,andT3inall4groups(?).attimeT0:Patientswithhypertensionhadhigherbloodglucoseandneutrophilpercentagethanthoseofnormal(P0.01)AttimeT3,bloodglucoseandleukocytecountweresignificantlydifferentbetweentwoanesthesiamethods,differentweredependingonthepresenceofhypertensionhistoryCgrouphadlowerbloodglucoseandleukocytecountthanthoseinAgroup(P0.05).therewasnosignificantdifferentbetweenBgroupandDgroup.Anesthesiamethodshadnoeffectonneutrophilpercentage,Results,Discussion,Hs-CRPreflectthelevelofvasculardiseaseinpatientswithhypertensionandcorrelatetotheseverityofvascularlesionwhetherHs-CRPcanbeusedastheindependentdiseaseprognosisindicatorcantbedeterminedAnumberofindicatorsshouldbeusedtoconductacomprehensiveassessmentofthedegreeofstressthisstudychosethebloodglucoseandleukocytecountandneutrophilpercentagewhichwillnormallyincreaseafterneurosurgeryastheindex.,Discussion,ThisresultsshowedthatpatientswithhistoryofhypertensionshowedtheHs-CRPexpressionlevelandneutrophilpercentageweresignificantlyhigherthaninpatientswithouthypertensionsuggestingpatientswiththehistoryofhypertensionhadseveresystemicinflammatoryresponseandcertainbloodvascularlesionsThisresultshowedthatinallgroupsHs-CRPat24hoursaftersurgerysignificantlyincreased.Meanwhile,bloodglucose,leukocytecount,andneutrophilpercentagegraduallyincreasedwithin24hoursaftersurgery.suggestedapparentstressresponseoccurredat24hoursaftersurgery.,Discussion,Studieshaveshownthathighbloodglucoseandhypertensionarerelateddiseasesandtheyhavecommonriskfactors.Anabnormalglucosemetabolismwasdiagnosedin57.1%ofthenew-onsethypertensivepatientswithoutpreviouslydiagnoseddiabetesinChineseHanpopulation.TheintracraniallesionsandvasculardiseasecoupledwiththeimpactofpsychologicalfactorareeasytocausethepreoperativehighbloodglucosewithintheneurosurgicalpatientsThisstudyshowedthatpreoperativebloodglucoselevelsinpatientswithhistoryofhypertensionsignificantlyincreasedbutthevaluewasstillwithinthenormalrange.,Discussion,Studieshaveshowedthatpropofolattenuatedtheincreaseinplasmabloodglucosetotalintravenousanesthesiacanbetterinhibittheincreaseofcellularinterleukin-6(IL-6),norepinephrine(NE),cortisol(COR)duringthepreoperativeperiodandstressresponseUsingpropofolformaintenanceofanesthesiaincardiopulmonarybypassisassociatedwithalessadverseinflammatoryprofilethanisisofluoranewhichsupportsthehypothesisthatpropofolhasanti-inflammatoryactivityAnanestheticregimencombiningpropofolandremifentanilattenuatesthestressresponsemoreefficientlythanaisofluraneremifentanilcombinationinpatientsscheduledfordiagnosticgynecologiclaparoscopy,Discussion,ThisstudyshowedthattotalintravenousanesthesiacansignificantlyreducepostoperativeHs-CRPlevelscomparedwithbalancedanesthesiabothhypertensionornormal.therewasnosignificanteff